Healthcare Provider Details

I. General information

NPI: 1790478360
Provider Name (Legal Business Name): LIGHTHOUSE GUIDECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BRENDAN LN APT 8
NORTH OLMSTED OH
44070-2236
US

IV. Provider business mailing address

3801 BRENDAN LN APT 8
NORTH OLMSTED OH
44070-2236
US

V. Phone/Fax

Practice location:
  • Phone: 216-280-0730
  • Fax:
Mailing address:
  • Phone: 216-280-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN ELIZABETH GABORKO
Title or Position: CEO/OWNER
Credential:
Phone: 216-280-0730